John Myers
Insulin therapy is not always recommended for type 2 diabetes: Doctors should weigh up the benefits of treatment. Alternatives may include a change in diet, exercise, and medication.
Insulin is an endogenous hormone, the administration of which can lead to undesirable side effects such as weight gain. In addition, the body can get used to the insulin, so that an ever higher dose is required. Possible consequences are obesity, the risk of heart attack, and stroke can increase. Therefore, in type 2 diabetes, insulin therapy should only be carried out if alternative forms of treatment are not sufficient. In the case of type 1 diabetes, however, permanent treatment with the hormone is essential.
Type 1 and type 2 diabetes – the differences
Insulin allows cells in the muscles and organs to absorb and utilize sugar from the blood, and the blood sugar level drops. The body stores excess sugar as fat reserves.
- In type 1 diabetes mellitus, the pancreas produces little or no insulin, so it has to be injected under the skin.
- In type 2 diabetes mellitus, the body cells become resistant to insulin. The pancreas has to produce more and more of the hormone to keep the sugar metabolism going and lower the blood sugar level – until at some point it can’t do it anymore.
Weight gain: Insulin therapy does not always make sense
Doctors often use insulin too early for type 2 diabetics, although it can have serious consequences for those affected: the insulin makes the circulating sugar in the blood particularly well utilized and stores it as fat deposits. Body weight increases – and those affected need even more insulin.
Diabetes therapy: drugs instead of insulin
In most cases, type 2 diabetes can be controlled without insulin. If a change in diet and increased exercise is not enough to permanently lower blood sugar levels, medication can help. They have proven to be clearly superior to insulin therapy in many studies:
- GLP-1 analogs (gliptins) stimulate the pancreas to release more of its own insulin. They reduce appetite, reduce obesity, and the risk of heart attack and stroke.
- SGLT-2 inhibitors (guillotines) work through the kidneys and ensure that more sugar is excreted from the blood through the urine. This also reduces body weight and the risk of heart attack and stroke.
The aim of therapy with medication is to push type 2 diabetes back to a milder stage and to significantly reduce body weight. This saves those affected by insulin therapy from many possible consequential damages.
False financial incentives for insulin therapy
Despite its disadvantages, many doctors prescribe insulin therapy for type 2 diabetes. Early and primary insulin therapy is not even provided for in the scientific guidelines.
The new diabetes drugs, on the other hand, are used relatively rarely. There are two main reasons for this:
- The active ingredients are more expensive than insulin – if they are used too frequently, doctors have to fear financial restrictions.
- Statutory health insurance companies benefit from substantial compensation payments from the risk structure compensation fund if their policyholders have to inject insulin.
